WORKSITE SAFETY INSPECTION

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

WALK AROUND OF FACILITY / PROPERTY

• Are there any violations?

  Yes

  No

• Violations Discovered

Violation

• Location of Violation

• Description of Violation

• Photographic Evidence

  Media

PREVIOUS UNCORRECTED VIOLATIONS

• Are there any uncorrected violations from a previous inspection?

  Yes

  No

• Uncorrected Violations

Violation

• Location of Violation

• Description of Violation

• Photographic Evidence

  Media

AREAS OF COMPLIANCE

• Are there any areas that are in compliance with State and Federal Regulations

  Yes

  N/A
Areas of Compliance

• Location of Compliance

• Description of Compliance

• Add media

  Media

RECEIPT

• This safety inspection is used to determine your compliance with the Occupational Safety and Health Administration (OSHA) standards and practices. Any violations discovered may be utilized to help determine the areas of concern that need addressing.
  
  Your signature for receipt of this report acknowledges your understanding that if any violations are discovered they will be corrected as soon as possible. You also understand that by failing to correct any violations discovered, you will be held liable for any violations that may be discovered during a safety inspection from OSHA or your State Enforcement Agency.
  
  You also agree not to hold Employer Advantage and/or its representative liable for any violations discovered during a safety inspection conducted by any investigator or enforcement officer.
  
  Refusing to sign this report does not in any way release you from any liability.

• Assessor

  Sign

• Company Representative

  Sign